ObjectivesTo explore the statistical performance of different methods for meta-analysis of single rates with zero events so as to provide evidence for selecting meta-analysis methods in evidence-based research.MethodsThrough Monte-Carlo simulations, we evaluated the performance of various transformation and correction methods for meta-analysis of single rates with zero events, considering the point estimate bias, confidence interval coverage and width.ResultsWhen the overall event rate was above 30%, all methods showed good statistical performance. As the event rate dropped, log, logit, and arcsine transformations could still maintain good performance. However, when the event rate was less than 5%, only Freeman-Tukey transformation showed excellent performance.ConclusionsThe meta-analysis of single rate based on Freeman-Tukey transformation is robust, and should be recommended as the preferable choice of meta-analysis of single rate with zero events.
Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.
【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
From April 1984 to March 1994, 31 reconstructive thumbs or fingers were followedup, including 16 cases with free neurovascular big toe nail skin flap and frozen preserved phalanxjointtendon composite allografts as well as 15 cases withfree second toe transfer. The method had the advantage of more fingers could bereconstructed and fewer toes would be lost. The decision of the site of reconstruction of finger, the augmentation of narrow web space between the thumb and the index finger, the prevention and treatment of vascular crisis and the degeneration of allogenic joint were discussed. It had been found that preserving the allogenic finger below -30℃ may lower the immunoreaction of the allogenic tissues. It was emphasized that the viable tissues should be preserved during the emergency debridement, so as to facilitate the following reconstruction procedure.
Abstract: Objective To study the impact of different kinds of mechanical circulation support devices on plasma free hemoglobin(FHb). Methods From Mar. 2004 to Dec. 2005, 20 patients received mechanical circulation support in Fu Wai Hospital, who were divided into 4 groups according to the different type of supporting devices. 9 got extracorporeal membrane oxygenation (ECMO) treatment, 8 received BVS5000 left ventricular support, 2 got MEDOS left ventricular support and 1 received AB5000 left ventricular support. Random control group included 9 cardiotomy patients after CPB supporting and 9 patients with offpump coronary artery bypass grafting during the same period. Parameters such as FHb, Tbil, Dbil, Cr and BUN were monitored throughout the supporting term. The results were compared according to the different types of mechanical circulation support devices. Results The elevation of FHb caused by CPB could be decreased to normal within 1d. However, in BVS5000 group, the elevated FHb level decreased to normal till 2 days later. The others mechanical circulation support devices such as ECMO, MEDOS, AB5000 elevated the FHb throughout the whole supporting period. Compared with those in ECMO group, the patients in BVS5000 group had obviously lower level of FHb since the third day after the beginning of supporting. In patients who got ECMO treatment, there was a trend that the elevation degree of FHb was lower in those with support flow rate less than 2.5 L/min. For most patients got devices support, there was also an elevation of Tbil and BUN level during the supporting period. Conclusion Mechanical circulation support devices, such as ECMO, BVS5000, MEDOS and AB5000, can cause red cell destruction in acceptable level. BVS5000 has much smaller impact on cell destruction than others do in postoperative patients.
linically,free neurovascular warparound flap big toe is generally used as one of the methods forthe reconstruction of thumb. The fate of the donor foot , and the various problems brought about bythe transfer, however, had not drawn enough concentration from the surgeons.Free warparound flap transfer was performed on 107 patients and 62 cases of the total werefollowed-up. It was found that the results of the transfer were generally satisfactory to the thumb,but much were complained about ...
Objective To explore the method of fabricating freeze-dried demineralized bone matrix with nanoscale topography (nFDBM) and to investigate the feasibility of reconstruction of tissueengineered bone with the novel scaffold. Methods Allogenic dogs’ phalangeal cortical bone was fabricatedinto freeze-dried demineralized bone (FDBM) with modified Urist’s method. FDBM was subjected toNd∶YAG laser irradiation under special conditions. The surface topography was identified by atomic force microscope(AFM) and scanning electron microscope (SEM). The osteoblasts were induced from autologous mesenchymal stem cells (MSCs) and mixed with nFDBM and FDBM in vitro.The effects of the different topography oncellbehavior was identified by SEM. The complex of nFDBM and osteoblasts wereimplanted into fascial bags on dogs’ back (experimental group A) and dogs’ phalangeal defects on right (experimental group C), while FDBMosteoblast complex (control group B) and unique FDBM (control group D) were implanted into the corresponding sites on left as control groups. The osteogenic status was assessed by X-ray, HE and SEM at 4, 8 and 12 weeks after surgery. Results The surface of FDBM subjected to Nd∶YAG laser irradiation resulted in well-defined three-dimensional nanoscale grooves (150 nm in depth and 600 to 800 nm in width). When the osteoblasts were implanted on the scaffold, the cells adhering to nFDBM were morethan those to FDBM and secreted more extracellular matrix. Either new bone-likethin layer on the nanoscale surface or a lot of new boneformation inner the experimental complex was observed by HE after 12 weeks of surgery and the experimental complexes were partially calcified at the same time, while the control groups almost had no osteogenic phenomena. Conclusion Nd∶YAG laser could produce nanoscale grooves on the FDBM surface. The nanoscale grooves are conductive to adherence, proliferation and matrix secretion of osteoblasts. Complexes by tissue engineering and nanoscale technology have some osteogenic abilities in vivoafter implanted the animal model.
Objective To investigate the clinical value of occlusal guide plate combined with intermaxillary fixation screw in mandibular defect repair with free fibular flap. Methods Between August and December 2011, 7 patients with mandibular tumor were treated, including 5 cases of ameloblastoma and 2 cases of gingival cancer. Of 7 patients, 4 were males and 3 were females, aged 32-65 years (median, 50 years). Occlusal guide plate was prepared and the implanted position of intermaxillary fixation screws was determined preoperatively. Hemimandibulectomy was performed in 5 cases, half mandibular segmental resection with condyle reservation in the other 2 cases. The free fibular flaps of 11-13 cm in length were harvested for repairing mandibular defects. When the free fibular flaps were fixed, the occlusal guide plate and intermaxillary fixation screws were utilized to restorate the occlusal relation. The donor site was sutured directly. Results The average operation time was 9.5 hours (range, 7-12 hours). All free fibular flaps survived completely. All incisions at the donor site and recipient site healed by first intention. All patients were followed up 10-14 months with an average of 12.3 months. All patients had symmetrical face, good occlusal relation, normal mouth opening, and normal mandibular lateral movement, and no pain of bilateral temporomandibular joints occurred. Panoramic tomography showed good mandibular contour and the suitable emplacement of fibular flaps postoperatively. No tumor recurrence occurred during follow-up period. Conclusion When repairing the mandibular defect with free fibular flap, occlusal guide plate with intermaxillary fixation screw contributes to simplifying operation, accurate recovery of the appearance and occlusal relation, and improving the oral comfort level postoperatively.
Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.